Provider Demographics
NPI:1598541427
Name:DYNAMIC WOUND CARE LLC
Entity Type:Organization
Organization Name:DYNAMIC WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP, AGACNP-BC
Authorized Official - Phone:405-315-8440
Mailing Address - Street 1:7017 SW 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-3739
Mailing Address - Country:US
Mailing Address - Phone:405-315-8440
Mailing Address - Fax:405-653-1444
Practice Address - Street 1:7017 SW 90TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-3739
Practice Address - Country:US
Practice Address - Phone:405-315-8440
Practice Address - Fax:405-653-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty